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Use of Tocilizumab for Severe Hantavirus Pulmonary Syndrome: A MEURI Case Series With Contextual Comparisons
This is a descriptive case series at Hospital Zonal de Bariloche Dr Ramón Carrillo, San Carlos de Bariloche, Argentina, patients with laboratory-confirmed severe hantavirus pulmonary syndrome and requiring intensive care unit (ICU) admission. Ten met eligibility criteria for tocilizumab; five received tocilizumab and five did not. In the five eligible non-treated patients, two were diagnosed when they were already in refractory shock, precluding timely administration, and three did not receive tocilizumab because the drug was unavailable when treatment was being considered. Four of five tocilizumab-treated patients survived to ICU discharge. The fifth treated patient died after rapid progression to refractory shock. All five eligible non-treated patients died after ICU admission.
Characteristics of Patients Hospitalized with Measles During an Outbreak — West Texas, January–March 2025
During January 20–March 18, 2025, a total of 325 confirmed measles cases were reported; (18.5%) patients were hospitalized, (90.7%) were aged <18 years, and (88.9%) had no underlying medical conditions. None of these had documented vaccination with the MMR. They had pneumonia (72.2%), dehydration (46.3%), hepatitis (1.9%), and febrile seizures (1.9%). (70.4%) hospitalized patients required supplemental oxygen, (7.4%) were admitted to an intensive care unit, (3.7%) required intubation and mechanical ventilation, and (1.9%) died.
Real-world Emergence of Nirsevimab Resistance in Breakthrough Infections with Respiratory Syncytial Virus-B: A Multicentre Observational Study in France
These results come from a study conducted in hospital settings (inpatients and outpatients) across France during the 2024–25 RSV season. Among 1,023 RSV-infected infants, 858 (83·9%) had full-length RSV genome sequences: 419 (48·8%) from nirsevimab-treated breakthrough infections (212 [50·6%] RSV-A, 207 [49·4%] RSV-B) and 439 (51·2%) from nirsevimab-naive infants (192 [43·7%] RSV-A, 247 [56·3%] RSV-B). Resistance-associated substitutions (RASs) were identified in two of 195 RSV-A breakthrough infections (1·0%) and in 23 of 184 RSV-B breakthrough infections (12·5%). In RSV-A, the only RAS was F:K209E, conferring intermediate resistance. In RSV-B, resistance was more frequent and diverse than in RSV-A: 12 of 23 (52.2%) resistant viruses carried a substitution at residue 208 (F:N208D, F:N208I, F:N208K, F:N208S, or F:N208Y). Additional novel substitutions, including F:I64V/F:K65E, F:K68I, F:L204S, and F:P205S, also mediated resistance. Notably, a resistant RSV-B variant (F:N208S) was detected almost one year after prophylaxis. No resistant RSV was detected in nirsevimab-naive infants. Resistance to nirsevimab in RSV-B can emerge in real-world settings, affecting around 12% of breakthrough infections and showing greater diversity than previously recognised.
SARS-CoV-2 Vaccination and Attenuation of Breakthrough Infection Severity: A Systematic Global Review and Meta-analysis.
These are the results of a systematic selection and meta-analysis of studies identified from a living systematic review of global observational studies reporting vaccine effectiveness (VE) against symptomatic infection and hospitalization. Authors computed the relative VE (rVE) against hospitalization versus symptomatic infection for matched VE pairs, representing vaccine-induced attenuation of severity. A total of 184 vaccine effectiveness (VE) pairs from 37 studies were included. The pooled rVE was 51% (95% CI: 39%, 60%) for broadly defined symptomatic infection and 19% (95% CI: 12%, 25%) for medically attended symptomatic infection, indicating significant attenuation of disease severity among vaccinated cases. Attenuation was weaker for Omicron subvariants when broadly defined symptomatic infection was the comparator. No significant differences were observed between vaccine platforms.
Metformin on the Presence of COVID-19 Symptoms 6 Months after Infection: The ACTIV-6 Randomized Clinical Trial
Authors conducted a quadruple-blinded, randomized, placebo-controlled trial of metformin for treating acute SARS-CoV-2 infection to prevent Long COVID symptoms in low-risk adults. The ACTIV-6 platform evaluated repurposed medications for mild to moderate COVID-19. Between September 19, 2023 and May 1, 2024, 2,983 outpatient adults ≥30 years with confirmed SARS-CoV-2 infection and ≥2 COVID-19 symptoms were included within seven days of symptom onset from 90 sites. Participants were randomized to metformin or placebo for 14 days. Post-acute sequelae of SARS-CoV-2 or death (PASCD) was ascertained by asking whether participants had symptoms they attributed to COVID-19 on day 180. Secondary outcomes included clinician-diagnosed Long COVID. There were no deaths. Overall, 96 (3.2%) reported COVID-19 symptoms on day 90, 101 (3.4%) on day 120, and 79 (2.6%) on day 180.
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